THE PSYCHOSOCIAL ASPECTS OF COSMETIC DERMATOLOGY in VS .NET

Painting QR Code 2d barcode in VS .NET THE PSYCHOSOCIAL ASPECTS OF COSMETIC DERMATOLOGY

CHAPTER 40 THE PSYCHOSOCIAL ASPECTS OF COSMETIC DERMATOLOGY
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BODY DYSMORPHIC DISORDER
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Body dysmorphic disorder (BDD) is a psychiatric condition defined in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as a preoccupation with an imagined defect in appearance56 The preoccupation causes impairment in social, occupational, or other important areas of functioning BDD is frequently associated with significant psychologic distress and may lead to suicidal ideation and suicide attempts57 In fact,
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a study in the British Journal of Dermatology reported that most dermatology patients who committed suicide had acne or BDD58 BDD often leads to unnecessary cosmetic procedures The most common areas that concern these patients are the skin, hair, and nose59 For several obvious reasons, it is important for the cosmetic dermatologist or plastic surgeon to identify these patients during history and prescreening BDD can lead to significant morbidity as well as a disproportionately high number of risks for unnecessary procedures In addition, these patients can be difficult to treat because they are often dissatisfied with the outcomes of the treatments they do receive60,61 Phillips et al screened 268 patients from two different environments: a general dermatology outpatient practice in a community setting and a dermatologic cosmetic surgery outpatient practice at a university teaching hospital59 They found that 119% of patients screened positive for BDD Interestingly, the patients treated in the cosmetic surgery practice had a lower rate of BDD (100%) than did those in the general dermatology practice (144%); however, one-third of eligible subjects in the cosmetic practice refused to complete the questionnaire This may have affected the study results, which also revealed that BDD is as common in men as it is in women In an investigation of female college students body images as well as their experiences and attitudes regarding cosmetic surgery, Sarwer et al found that two-thirds of the 559 participants surveyed knew someone who had received cosmetic surgery (with approximately one-third reporting that a family member had undergone surgery), 5% had undergone cosmetic surgery themselves, and 25% screened positive for BDD62 Cosmetic dermatologists and plastic surgeons should be aware of the possibility that this syndrome is affecting some patients and should encourage such patients to receive psychiatric help BDD can be successfully treated with serotonergic antidepressants and cognitive-behavioral treatments63 Of course, confronting these patients is very difficult and the approach used must be individualized for each patient In the study by Sarwer et al, it is worth noting that participants expressed an overall favorable attitude regarding cosmetic surgery, with an association found between such favorable attitudes and greater psychologic stock placed in physical appearance as well as internalization of beauty imagery absorbed from various mass media62
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MOTIVATIONS FOR SEEKING COSEMTIC PROCEDURES
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The media often cite the disproportionate number of overweight people in the United States, an epidemic of obesity, which invariably leads to recitations of the importance of exercise and good health, usually associating these qualities with youthfulness and beauty The implication is that one s social acceptance and even professional success hinge on these qualities64 Clearly, body dissatisfaction, exogenous criticism, and the feeling that one fails to measure up to cultural standards of appearance and beauty propel people to change their behavior, lifestyles, and appearance In a study by Santor and Walker, 75 people were examined for the degree to which their appraisals of self-worth were linked to the appraisals of how interested other people were in them The investigators found a strong association between the degree to which people measure certain attributes of self-worth and the degree to which individuals believed others were interested in them65 In other words, the amount of interest one thought others showed them mediated the study subjects expression of confidence in their own physical attributes, attractiveness, and sense of social self-worth With ideal imagery playing a greater role in daily life, the chances that individuals will internalize such iconography and use the implications against themselves and others grows immeasurably This is why motivations for cosmetic enhancement, while always personal, can include social and even professional elements66 Studies have shown, for instance, that attractive children and adults are judged and treated more positively than unattractive children and adults, even by those who know them, and such advantages persist into every age category18,67 As others have noted, the reasons to undergo cosmetic procedures are always personal, based on an individual s psychologic constitution, and inextricably linked to body image, which is based on a convoluted interplay of factors both outward and inward, objective and subjective The essential value of the procedure, though, is derived from the patient s opinion and reaction to the result and not from the general perception of the visible change as determined by those in a patient s life68 Of course, a patient s assessment of the result may be tempered by the reactions of her or his family and friends Research does show that enhancing a physical characteristic
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and improving physical attractiveness positively affects personality and, thus, interpersonal interactions, the results of which are internalized, exerting a positive effect on self-esteem69 An interesting recent study of cosmetic surgery in adolescents is illustrative, practically by definition, of the social and internalized pressures regarding appearance that can drive teenagers to seek cosmetic enhancement, as well as the potential psychologic and physical boosts that such procedures can deliver The responses to 12 survey questions administered to 86 of 165 adolescents who underwent surgery between January 2001 and June 2005 revealed no statistically significant differences between males and females regarding postoperative satisfaction, with an overall satisfaction rate of 9383% Further, postoperative satisfaction was found to be strongly related to overall life satisfaction, self-esteem, and body image70
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